Gustavo Pittaluga y la expedición para el estudio de la enfermedad del sueño en los territorios españoles del golfo de Guinea (1909) / Gustavo Pittaluga and the expedition to study sleeping sickness in the Spanish territories of the Gulf of Guinea (1909

Introducción. La enfermedad del sueño, o tripanosomiasis africana, produjo a principios del siglo x x una gran mortalidad. Por ello, las potencias coloniales organizaron diversas expediciones científicas, que favorecieron el conocimiento de la enfermedad. Objetivo. Estudiar la primera investigación realizada en España sobre tripanosomiasis africana y en el campo de la medicina tropical, mediante una expedición científica organizada por Cajal a los territorios españoles del golfo de Guinea en el año 1909. Desarrollo. Dirigió la expedición el parasitólogo Gustavo Pittaluga, que sería una de las figuras más importantes en la medicina y la salud pública en España durante el primer tercio del siglo x x. Le acompañaron Luis Rodríguez Illera y Jorge Ramón Fañanás, hijo de Cajal. Recorrieron durante cuatro meses los territorios de Guinea, recogiendo información clínica y epidemiológica sobre la enfermedad del sueño y otras enfermedades, examinando a numerosos pacientes, a los que se les realizaba análisis hematológicos y parasitológicos. En la descripción clínica de los 14 pacientes con tripanosomiasis, encontramos la primera descripción de un síndrome de opsoclono-mioclono. En un caso se realizó estudio patológico cerebral. Se hicieron también importantes estudios entomológicos y estudios experimentales sobre la tripanosomiasis. Conclusiones. Esta expedición se enmarca dentro del impulso de renovación de la ciencia española, que Cajal encabezó a través de la Junta de Ampliación de Estudios recién creada. En las investigaciones realizadas en Guinea, Pittaluga mostró un alto nivel científico, tanto en clínica e higiene como en parasitología y entomología, equiparable a otros estudios europeos coetáneos (AU)

Introduction. Sleeping sickness, or human African trypanosomiasis, caused an important mortality at the beginnings of the twentieth century. For this reason the European colonial countries organized several scientific expeditions which contributed decisively to the knowledge of the disease. Aim. To study the first investigation performed in Spain on African trypanosomiasis and in the field of tropical medicine, which was accomplished by a scientific expedition to the Spanish territories in the Gulf of Guinea organized by Cajal in 1909. Development. The parasitologist Gustavo Pittaluga, who became one of the most outstanding figures in Spanish medicine and public health during the first third of the twentieth century, commanded the expedition. Other members were Luis Rodríguez Illera and Jorge Ramón Fañanás, Cajal’s son. Along four months they travelled through the Spanish territories of Guinea, collecting clinical and epidemiological information on sleeping sickness and other diseases, and examining a great number of patients, who had hematological and parasitological studies performed. In the clinical description of the 14 cases of trypanosomiasis studied we have found the first description of the opsoclonus-myoclonus syndrome. A pathological study of the brain was performed in one case. In addition, important entomological studies and experimental investigations on trypanosomiasis were also performed. Conclusions. This expedition took place in the context of the impulse of renovation of Spanish science headed by Cajal through the Junta de Ampliación de Estudios, recently created. In the investigations performed in Guinea, Pittaluga demonstrated a high scientific standard in the fields of clinical medicine, hygiene, parasitology and entomology, comparable with other contemporary European studies (AU)

Causes of unplanned hemodialysis initiation.

Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis occurred in 20 patients (47%), without any differences with the 23 patients who began planned hemodialysis, in none of the clinical or demographic parameters analyzed. The main cause of unplanned hemodialysis was the acute exacerbation of chronic kidney disease stage 3 or 4, previously stable, secondary to an unforeseeable intercurrent process (8 patients, 40% of the cases). One patient began after a non-recovery acute renal failure and in other 6 patients, the reason of unplanned hemodialysis initiation was not attributable to the operation Health System (in 3 cases unknown kidney chronic disease and in the other 3 cases it was patient´s responsibility). Only in 5 cases (25%), the cause could be corrigible. Most causes of unplanned hemodialysis does not come from the healthcare organization and therefore not easy to resolve it. Consequently, the objective of the Quality Group will be difficult to be achieved.

Causas de inicio no programado del tratamiento renal sustitutivo con hemodiálisis / Causes of unscheduled haemodialysis initiation

La mitad de los enfermos que comienzan tratamiento con hemodiálisis periódica lo hacen con un catéter venoso como acceso vascular (inicio no programado). Un objetivo del Grupo de Gestión de Calidad de la Sociedad Española de Nefrología es conseguir que el 80% de los enfermos comiencen la hemodiálisis a través de una fístula arteriovenosa. Hemos querido revisar las causas que condicionan en la actualidad el inicio no programado, para analizar cuáles pueden ser corregibles. En el año 2010, 43 enfermos comenzaron tratamiento con hemodiálisis periódica en el Hospital Ramón y Cajal de Madrid. La edad media fue de 61 años, el 79% eran hombres, la etiología más frecuente fue la diabetes mellitus (23%) y el índice de Charlson era de 6,3 ± 2,6. El inicio no programado de la hemodiálisis ocurrió en 20 enfermos (47%), sin objetivarse diferencias con los 23 enfermos que comenzaron (..) (AU)

Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis (..) (AU)

Inicio de diálisis tras trasplante renal. ¿Se empieza en peor situación que la de los enfermos renales de novo? / Dialysis after kidney transplant failure: do patients start in a worse condition than the general population with chronic kidney disease?

Introducción: Los pacientes trasplantados renales con disfunción crónica del injerto que precisan reinicio de diálisis constituyen un grupo cada día más prevalente, con características especiales que los diferencia de la población general con enfermedad renal crónica (ERC). El objetivo del presente estudio fue analizar y comparar la situación clínica al inicio de diálisis y su evolución en el primer año endos grupos de enfermos, trasplantados y no trasplantados, de acuerdo con los criterios fijados en las guías K/DOQI. Asimismo, se estudia si la modalidad de terapia renal sustitutiva (TRS) escogida a su retorno a diálisis pudiera condicionar una mejoría clínica de los pacientes trasplantados. Material y métodos: Estudio retrospectivo y observacional en 106 enfermos con ERC estadio 5 seguidos en el Hospital Ramón y Cajal. Dichos enfermos fueron divididos en dos grupos. El primero estaba formado por 50 enfermos con ERC de riñones nativos que comenzaron tratamiento con diálisis entre los años 2000 y 2009. El segundo grupo estaba constituido por 56 enfermos trasplantados con disfunción del injerto que precisaron retorno a diálisis entre los años 1997 y 2009. Se recogieron parámetros de anemia, función renal, metabolismo calcio-fósforo, factores de riesgo cardiovascular y estado nutricional en el momento de comenzar tratamiento con diálisis y un año después. Resultados: Al inicio de diálisis ambos grupos presentan valores similares en los parámetros analizados con excepción (..) (AU)

Background: Patients with renal graft dysfunction constitute an increasingly prevalent group of end-stage kidney disease (ESKD) patients that require dialysis therapy. These patients have special characteristics that set them apart from the ESKD general population. The aim of this study was to analyse the clinical condition and evolution of patients entering dialysis with a failed kidney graft at the time of restarting dialysis and over a year of therapy according to the K/DOQI guidelines, and to compare them with incidental patients with end-stage kidney disease. We also investigated whether the modality of kidney replacement therapy may determine the clinical improvement of transplant patients. Material and Method: This is a retrospective observational study of 106 patients with ESKD followed up in the Ramon y Cajal Hospital. They were classified in two groups. Group one was made up of 50 failed native kidney patients who started dialysis between 2000and 2009. Group two was comprised of 56 transplant patients with graft dysfunction who returned to dialysis between 1997 and 2009. We studied parameters of kidney (..) (AU)

Dialysis after kidney transplant failure: do patients start in a worse condition than the general population with chronic kidney disease?

BACKGROUND: Patients with renal graft dysfunction constitute an increasingly prevalent group of end-stage kidney disease (ESKD) patients that require dialysis therapy. These patients have special characteristics that set them apart from the ESKD general population. The aim of this study was to analyse the clinical condition and evolution of patients entering dialysis with a failed kidney graft at the time of restarting dialysis and over a year of therapy according to the K/DOQI guidelines, and to compare them with incidental patients with end-stage kidney disease. We also investigated whether the modality of kidney replacement therapy may determine the clinical improvement of transplant patients. MATERIAL AND METHOD: This is a retrospective observational study of 106 patients with ESKD followed up in the Ramon y Cajal Hospital. They were classified in two groups. Group one was made up of 50 failed native kidney patients who started dialysis between 2000 and 2009. Group two was comprised of 56 transplant patients with graft dysfunction who returned to dialysis between 1997 and 2009. We studied parameters of kidney function, anaemia, calcium-phosphorus metabolism, cardiovascular risk factors and nutritional status at the time both groups started on dialysis and one year later. RESULTS: Both groups had a similar clinical status at the time they started on dialysis in most of the parameters analysed with the exception of anaemia. This was more severe in transplant patients, despite the fact that transplant patients received a higher dose of erythropoietin than non-transplant patients. One year later the main difference between both groups was the residual kidney function rate, higher in non-transplant patients. There were no significant differences in the parameters analysed in patients with a failed graft according to the modality of kidney replacement therapy. CONCLUSION: Failed transplant patients start dialysis with more severe anaemia than patients entering dialysis for the first time. Twelve months later both groups present a similar clinical condition with the exception of residual kidney function, higher in failed native kidney patients. The method of dialysis treatment after kidney transplant failure did not have a bearing on the clinical improvement of our patients.

[Post-encephalitic syndromes in the Spanish medical literature]. / Síndromes postencefalíticos en la literatura médica española.

AIM: A large number of patients with encephalitis lethargica developed different post-encephalitic syndromes (PES), which have an important medical and social impact. We studied the clinical and historical aspects of PES in Spain by reviewing the medical literature published in this country between 1918 and 1936. DEVELOPMENT: There are no statistical data concerning PES in Spain, although Spanish physicians drew attention to their high rate of prevalence and their repercussions on community health. Most of the 140 patients that were reviewed (74%) presented predominant Parkinsonism, but some features of Parkinsonism were observed in nearly all cases. Other movement disorders (focal dystonias, chorea, myoclonus, oculogyric crises, abnormalities affecting breathing rate) were described, as well as sleep, endocrine and vegetative disorders. Psychiatric disorders were often reported, the most frequent being bradyphrenia associated to Parkinsonism, but a hypomanic picture with impulsive behaviour was very characteristic among young people. PES was diagnosed on average two years after the episode of acute encephalitis lethargica, although it often appeared immediately afterwards. Many studies discuss the contribution made by PES to further our knowledge of the pathophysiology of extrapyramidal diseases and about the involvement of the basal ganglia in psychiatric and behavioural disorders. CONCLUSIONS: Despite the absence of statistical data, Spanish authors highlighted the important repercussions the PES had on community health, as well as the role they played in extending our knowledge of the pathophysiology of the basal ganglia. Cases of Parkinsonism were predominant, although all kinds of post-encephalitic manifestations were reported.

Síndromes postencefalíticos en la literatura médica española / Post-encephalitic syndromes in the spanish medical literature

Objetivo. Un gran número de pacientes de encefalitis letárgica desarrollaba diferentes síndromes postencefalíticos (SPE), de importante impacto medicosocial. Hemos estudiado los aspectos clínicos e históricos de los SPE en España, mediante una revisión de la literatura médica publicada en este país en el período 1918-1936. Desarrollo. No existen datos estadísticos sobre los SPE en España, aunque médicos españoles llamaron la atención sobre su alta prevalencia y su repercusión sociosanitaria. La mayoría de los 140 pacientes revisados (74%) presentaron parkinsonismo predominante, pero en casi todos se apreciaba algún rasgo parkinsoniano. Se describieron otros trastornos del movimiento (distonías focales, corea, mioclonías, crisis oculógiras, anomalías del ritmo respiratorio), así como trastornos del sueño, endocrinos y vegetativos. A menudo se comunicaron alteraciones psiquiátricas: la más frecuente era la bradifrenia asociada a parkinsonismo, pero fue muy característico un cuadro hipomaníaco con conducta impulsiva en jóvenes. El diagnóstico del SPE se realizó una media de dos años después del episodio de encefalitis letárgica aguda, aunque con frecuencia apareció inmediatamente después. En muchos trabajos se discute sobre la contribución de los SPE al desarrollo del conocimiento de la fisiopatología de las enfermedades extrapiramidales y sobre la implicación de los ganglios basales en los trastornos psiquiátricos y de conducta. Conclusiones. En ausencia de datos estadísticos, los autores españoles reflejaron la importante repercusión sociosanitaria de los SPE, así como su papel en el conocimiento de la fisiopatología de los ganglios basales. Predominaron los parkinsonismos, aunque se describieron todo tipo de manifestaciones postencefalíticas

Aim. A large number of patients with encephalitis lethargica developed different post-encephalitic syndromes (PES), which have an important medical and social impact. We studied the clinical and historical aspects of PES in Spain by reviewing the medical literature published in this country between 1918 and 1936. Development. There are no statistical data concerning PES in Spain, although Spanish physicians drew attention to their high rate of prevalence and their repercussions on community health. Most of the 140 patients that were reviewed (74%) presented predominant Parkinsonism, but some features of Parkinsonism were observed in nearly all cases. Other movement disorders (focal dystonias, chorea, myoclonus, oculogyric crises, abnormalities affecting breathing rate) were described, as well as sleep, endocrine and vegetative disorders. Psychiatric disorders were often reported, the most frequent being bradyphrenia associated to Parkinsonism, but a hypomanic picture with impulsive behaviour was very characteristic among young people. PES was diagnosed on average two years after the episode of acute encephalitis lethargica, although it often appeared immediately afterwards. Many studies discuss the contribution made by PES to further our knowledge of the pathophysiology of extrapyramidal diseases and about the involvement of the basal ganglia in psychiatric and behavioural disorders. Conclusions. Despite the absence of statistical data, Spanish authors highlighted the important repercussions the PES had on community health, as well as the role they played in extending our knowledge of the pathophysiology of the basal ganglia. Cases of Parkinsonism were predominant, although all kinds of post-encephalitic manifestations were reported

[How did encephalitis lethargica affect Spain? An analysis of the cases reported between 1918 and 1936]. / Cómo fue la encefalitis letárgica en España? Análisis de los casos publicados entre 1918 y 1936.

AIM: Encephalitis lethargica spread as a pandemic over the period 1918-1921. Clinically, it displayed an important degree of polymorphism and the clinical presentation varied from one outbreak to the next and from one region to another. Few studies have been carried out on the encephalitis lethargica epidemic in Spain. To determine the characteristics of its clinical and developmental features, we reviewed the cases reported in the Spanish medical literature over the period 1918-1936. DEVELOPMENT: A total of 120 cases were analysed. Most of them (75%) occurred during the winter of 1919-1920. The mean age was 27 years (range: 0-59 years). Most of them presented feverish syndromes (82%). The most frequent neurological symptoms were disorders affecting the cranial nerves, especially the oculomotor nerves, sleep rhythm disorders, altered mental or conscious status, pupillary abnormalities and movement disorders. Important variations were observed in the clinical presentation and in the developmental course. Although most cases did not present pure clinical forms, the predominant forms were somnolent-ophthalmoplegic (46%) and hyperkinetic (17%), which were associated with delusions with chorea or myoclonias. The most uncommon were amyostatic forms (Parkinsonian, 4%). The mortality rate was 23%. Most of the survivors (69%) were cured in the acute phase with no significant sequelae. CONCLUSIONS: The maximum incidence of encephalitis lethargica in Spain was registered during the winter of 1919-1920. It presented an important degree of clinical polymorphism, with predominance of an association between lethargy and ophthalmoplegia, and was linked to a high mortality rate.

[Catheter-related bacteremia due to Streptomyces: clinical significance of Streptomyces isolation in cultures]. / Infección asociada a catéter por Streptomyces: significado clínico del aislamiento de Streptomyces en cultivos.

OBJECTIVES: To evaluate the clinical significance of Streptomyces isolates in different clinical samples. MATERIAL AND METHODS: Review of the records of all cases of Streptomyces isolated from any clinical sample at a tertiary Hospital, during a seven-year period. RESULTS: Streptomyces was isolated from 13 patients. All of them had underlying diseases. Only in one patient Streptomyces was considered to have a pathogenic role in the clinical picture. We report the third case of catheter-related infection caused by this microorganism. CONCLUSIONS: Streptomyces is usually isolated from patients with underlying diseases. Before considering them significative, Streptomyces isolates must be interpreted in the clinical context.

¿Cómo fue la encefalitis letárgica en España? Análisis de los casos publicados entre 1918 y 1936 / How did encephalitis lethargica affect Spain? An analysis of the cases reported between 1918 and 1936

Objetivo. La encefalitis letárgica se extendió como una pandemia en los años 1918-1921. Clínicamente presentaba un gran polimorfismo y la presentación clínica variaba en sucesivos brotes epidémicos y en diferentes regiones. La epidemia de encefalitis letárgica en España se ha estudiado poco. Para conocer sus características clínicas y evolutivas, hemos revisado los casos comunicados en la literatura médica española durante el período 1918-1936. Desarrollo. Se analizaron 120 casos. La mayor parte de ellos (75%) se presentó en el invierno de 1919-1920. La edad media fue de 27 años (rango: 0-59 años). La mayoría tuvo fiebre (82%). Los síntomas neurológicos más frecuentes fueron la alteración de pares craneales, sobre todo oculomotores, trastorno del ritmo del sueño, alteración del estado mental o de conciencia, anomalías pupilares y trastornos del movimiento. Hubo una gran variabilidad de la presentación clínica y del curso evolutivo. Aunque la mayoría de los casos no presentaban formas clínicas puras, predominaron las formas somnoliento-oftalmopléjicas (46%) y las hipercinéticas (17%), que asociaban delirio con corea o mioclonías. Más raras fueron las formas amiostáticas (parkinsonianas, 4%). La mortalidad fue del 23%. La mayor parte de los supervivientes (69%) se curó de la fase aguda sin secuelas significativas. Conclusiones. La encefalitis letárgica en España tuvo su máxima incidencia en el invierno de 1919-1920. Presentó una gran variabilidad clínica en la que predominaba la asociación de letargia y oftalmoplegía, y se asoció con una alta mortalidad

Aim. Encephalitis lethargica spread as a pandemic over the period 1918-1921. Clinically, it displayed an important degree of polymorphism and the clinical presentation varied from one outbreak to the next and from one region to another. Few studies have been carried out on the encephalitis lethargica epidemic in Spain. To determine the characteristics of its clinical and developmental features, we reviewed the cases reported in the Spanish medical literature over the period 1918-1936. Development. A total of 120 cases were analysed. Most of them (75%) occurred during the winter of 1919-1920. The mean age was 27 years (range: 0-59 years). Most of them presented feverish syndromes (82%). The most frequent neurological symptoms were disorders affecting the cranial nerves, especially the oculomotor nerves, sleep rhythm disorders, altered mental or conscious status, pupillary abnormalities and movement disorders. Important variations were observed in the clinical presentation and in the developmental course. Although most cases did not present pure clinical forms, the predominant forms were somnolent-ophthalmoplegic (46%) and hyperkinetic (17%), which were associated with delusions with chorea or myoclonias. The most uncommon were amyostatic forms (Parkinsonian, 4%). The mortality rate was 23%. Most of the survivors (69%) were cured in the acute phase with no significant sequelae. Conclusions. The maximum incidence of encephalitis lethargica in Spain was registered during the winter of 1919-1920. It presented an important degree of clinical polymorphism, with predominance of an association between lethargy and ophthalmoplegia, and was linked to a high mortality rate

Infección asociada a catéter por Streptomyces: significado clínico del aislamiento de Streptomyces en cultivos / Catheter-related bactermia due to Streptomyces: clinical significance of Streptomyces isolation in cultures

Objetivo. Evaluar el significado clínico del aislamiento de Streptomyces en distintas muestras clínicas. Material y métodos. Se revisaron historias clínicas de los pacientes con aislamiento de Streptomyces en cualquier muestra clínica durante un período de siete años en un hospital terciario. Resultados. Se aisló Streptomyces en 13 pacientes. todos tenían enfermedades subyacentes. Sólo en un paciente Streptomyces fue considerado responsable del cuadro clínico. Se presenta el tercer caso de infección asociada a catéter por este microorganismo. Conclusiones. Streptomyces habitualmente se aísla en pacientes con patología subyacente. Su aislamiento debe interpretarse en el contexto clínico del paciente para considerarlo significativo

OBJECTIVES: To evaluate the clinical significance of Streptomyces isolates in different clinical samples. MATERIAL AND METHODS: Review of the records of all cases of Streptomyces isolated from any clinical sample at a tertiary Hospital, during a seven-year period. RESULTS: Streptomyces was isolated from 13 patients. All of them had underlying diseases. Only in one patient Streptomyces was considered to have a pathogenic role in the clinical picture. We report the third case of catheter-related infection caused by this microorganism. CONCLUSIONS: Streptomyces is usually isolated from patients with underlying diseases. Before considering them significative, Streptomyces isolates must be interpreted in the clinical context

[Meningitis caused by multiresistant E. coli after an echo-directed transrectal biopsy]. / Meningitis por E. coli multirresistente tras biopsia transrectal ecodirigida.

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.

Meningitis por E. coli multirresistente tras biopsia transrectal ecodirigida / E. Coli multirresistant meningitis after transrectal prostate biopsy

La biopsia transrectal ecodirigida es actualmente el método más eficaz para el diagnóstico del carcinoma prostático. A pesar de que en la mayoría de los protocolos se emplea profilaxis antibiótica, las complicaciones infecciosas se encuentran entre las de mayor gravedad. Presentamos un caso de meningitis por E. coli multirresistente después de la realización de una biopsia transrectal de próstata a pesar de la profilaxis con quinolonas (AU)

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Althoug an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severes. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis (AU)